White Gallbladder Diarrhea and Green Bile Salts Diarrhea

Normally, bile that is produced in the liver, is temporarily stored in the gallbladder. From here the bile is secreted into the duodenum (small intestine) during digestion. It is mainly secreted when there are fats in the gut, like after a fatty meal. Bile emulsifies fat globules, which means that it breaks it down into smaller particles. This allows fat-digesting enzymes known as lipases to chemically break down the fat into smaller components.

Bile also causes the stool to have its characteristic brown color. It is made up on many substances which are mainly waste substances that are processed and secreted by the liver into the gallbladder. One substance within bile, known as bilirubin, is converted to stercobilin in the gut and this gives the stool its brown color. Therefore without bile and bilirubin, stool will not be tan to dark brown. Instead it appears pale than normal and even whitish in color.

White Diarrhea Due to Gallstones

Gallbladder stones are the most common cause of obstruction of bile flow. These gallstones may press on the main bile duct and obstruct it from the outside. This prevents the flow of bile into the duodenum. Furthermore a small gallstone may move from the gallbladder into the main bile duct thereby obstructing it from the inside. Symptoms of bile duct obstruction include one or more of the following:

  • Right upper abdominal pain (cramps) which is usually triggered within an hour after a meal, particularly a fatty/greasy meal.
  • Right shoulder and upper back pain may also occur as this radiates from the upper abdomen.
  • Nausea and vomiting
  • Jaundice – a yellow tinge of the skin and “whites” of the eyes.
  • White (pale, clay) colored bowel movements due to lack of bilirubin, which gives the stool its normal brown color.
  • Loose, foul smelling, sticky, floating, foul smelling stool, which contains unabsorbed fats (this is called steatorrhea: from Greek steato = fat; rhein = flow).
  • Dark urine may also occur as excess bilirubin is then excreted through the kidneys. It usually correlates with the paleness of stool.

The pain typically occurs as attacks which starts a period of time after eating a greasy meal and persists for several hours thereafter. It is described as a colicky pain and is therefore also referred to as biliary colic. However, it is important to note that gallstones may not always cause white diarrhea. Instead the stool may be paler than normal and this can go unnoticed.

Some people are more likely to develop gallstones. These are stones that form from the cholesterol and other precipitates in the bile. Women around the age of 40 years, who are obese and on hormone treatment or undergoing a change in the hormone levels tend to be more likely to develop gallstones. However, gallstones can occur in younger and older people as well as in men.

Read more on gallstones.

Diagnosis of Gallstones

Large gallstones (> 2 mm) in the gallbladder can be detected by ultrasound but small gallstones can only be detected only by  CT (computed tomography) scan. Gallstones in the bile ducts can be detected by CT or ERCP (endoscopic retrograde cholangio pancreatography), where a contrast dye is injected into bile ducts during upper GI endoscopy and then an X-ray taken.

Read more about gallbladder tests.

Treatment of Gallstones

Gallstones in the gallbladder are treated with surgical removal of the gallbladder. This is the first choice of treatment these days as gallstones often tend to recur. Sometimes the gallstones may be dissolved by oral administration of bile acids. Gallstones in bile ducts may also be removed during ERCP but gallbladder removal (cholecystectomy) is still the preferred method.

Green Diarrhea After Gallbladder Removal

After gallbladder removal, the bile is constantly flowing from the liver into the duodenum. Most of the bile salts from the bile are absorbed from the end part of the small intestine into the blood but this is not always the case. Bile salts that were not absorbed in the small intestine will reach the colon and speed up colonic movements.

This results in diarrhea as water from the stool will not have sufficient time to be absorbed. Furthermore colonic bacteria will not have enough time to convert bilirubin, which is green, to stercobilin, which is brown. As a result the stool is watery and green, or in others words it is green diarrhea.

Green diarrhea may also be worsened by other causes of diarrhea such as an infection of the digestive tract. This also speeds up movement through the bowels and in conjunction to the damage to the bowel wall, it increases water secretion into the gut while impairing water reabsorption.

It is also important to note that the greenish color of stool or green diarrhea may not arise from bile. Instead it may be due to green pigments in the food or beverages. These dyes or colorants may normall be broken down or masked during its transit through the gut. However, in diarrhea the movement through the bowel is rapid and as a result the green pigment may remain intact where it can then discolor stool.

Treatment of Green Diarrhea After Gallbladder Removal

Cholestyramine, taken orally, binds excessive bile salts in the bowel and allows it to be excreted with the stool without causing diarrhea (1). Cholestyramine may have several side effects, so this may not be an option for every case. A low-fat diet may help some affected people (1). Fiber from fiber-rich foods may also bind some bile salts and thereby prevent bile salt diarrhea (1).

Persistent diarrhea, irrespective of the cause, can lead to a diarrhea. This in turn may result in a host of complications and ultimately even culminate in death if not properly managed. Therefore rehydration is essential throughout the period when the diarrhea is present. This should involve the use of oral rehydrating solutions (ORS). If necessary, IV (intravenous) fluid administration may be necessary. Always consult with a doctor as soon as possible.

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References:

  1. Bile salt diarrhea  (Patient.co.uk)
About Jan Modric (249 Articles)
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